Overview
This lecture covers the recognition, assessment, and management of various chest injuries, differentiating between blunt and penetrating trauma, and key conditions such as pneumothorax, hemothorax, cardiac tamponade, flail chest, and commotio cordis.
Types of Chest Injuries
- Chest injuries include blunt (closed) and penetrating (open) trauma.
- Blunt trauma: skin intact, caused by impacts (e.g., steering wheel, seatbelt).
- Penetrating trauma: object pierces chest wall (e.g., knife, bullet, fractured rib).
- Always treat injuries interfering with breathing immediately.
Chest Anatomy & Physiology
- The chest protects vital organs: heart, lungs, major blood vessels.
- Pleura: double-layer lining around lungs, enables smooth movement during breathing.
- Diaphragm and intercostal muscles control breathing.
- Ventilation: movement of air in and out; oxygenation: process of getting Oâ‚‚ into blood.
Assessment and Management
- Scene safety and mechanism of injury are priorities.
- Inspect for breathing difficulties, chest wall movement, wounds, and signs of shock.
- Apply occlusive dressings to all penetrating chest injuries.
- Frequent reassessment of ABCs and interventions is critical.
- Rapid transport for life-threatening injuries.
- Use spinal immobilization if trauma may involve the spine.
Key Chest Injury Conditions
- Pneumothorax: air in pleural space, collapsed lung; treat open wounds with occlusive dressing or commercial flutter valve.
- Tension Pneumothorax: air buildup shifts organs, may cause tracheal deviation; requires rapid transport.
- Hemothorax: blood in pleural space, signs of shock; treat as pneumothorax with urgent transport.
- Hemopneumothorax: both air and blood in pleural space; needs surgical intervention.
- Cardiac Tamponade: fluid/blood in pericardium compresses heart; note Beck’s triad for diagnosis.
- Rib Fractures: localized pain, shallow breathing; provide oxygen and support.
- Flail Chest: multiple ribs broken in multiple places, paradoxical chest motion; support ventilation, do not splint chest.
- Traumatic Asphyxiation: compression of chest, JVD, cyanosis, facial petechiae.
- Blunt Myocardial Injury: bruised heart, irregular pulse, chest pain.
- Commotio Cordis: sudden cardiac arrest from chest impact during specific cardiac cycle phase.
Signs & Symptoms of Chest Injuries
- Pain worsened by breathing or movement.
- Bruising, crepitus, dyspnea, hemoptysis, cyanosis, abnormal chest expansion.
- Weak, rapid pulse; low blood pressure.
- Diminished or asymmetric breath sounds.
- JVD (jugular vein distension) and/or tracheal deviation in some conditions.
Key Terms & Definitions
- Pneumothorax — Air in pleural space causing lung collapse.
- Tension Pneumothorax — Air pressure shifts mediastinal structures, life-threatening.
- Hemothorax — Blood in pleural cavity.
- Hemopneumothorax — Both air and blood in pleural cavity.
- Cardiac Tamponade — Compression of heart due to fluid/blood in pericardium.
- Flail Chest — Segment of rib cage breaks in multiple places, moves paradoxically.
- Paradoxical Chest Motion — Chest section moves opposite to rest during breathing.
- Commotio Cordis — Cardiac arrest from blunt chest impact in susceptible phase.
Action Items / Next Steps
- Review Beck’s triad for cardiac tamponade.
- Practice identifying types of pneumothorax and their management.
- Study the "deadly dozen" chest injuries and their clinical signs.
- Complete assigned chapter reading on chest injuries.